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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700396
Report Date: 02/27/2024
Date Signed: 02/27/2024 09:39:00 AM

Document Has Been Signed on 02/27/2024 09:39 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HE, EMILYFACILITY NUMBER:
015700396
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
02/27/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Emily He- LicenseeTIME COMPLETED:
09:45 AM
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On 2/27/24, Licensing Program Analyst Briana Plumboy, met with licensee Emily He for an UNANNOUNCED CASE MANAGEMENT INSPECTION initiated by the licensee to change her on limit areas. Present for this visit was 3 infants, 2 preschool age children, and licensee's fingerprint clear and associated assistant/ mother in law Xianxiao Ng. The home was toured to conduct a Health and Safety Inspection. The facility currently operates 7 days a weeks, 24 hours per day. The licensee is aware children in care may not stay in care for over 23 hours.
The home consists of a living room, kitchen, dining room, 2 bedrooms, 1 master bedroom/master bathroom, studio (located through the double doors in the living room consisting of a bathroom, room, and hallway which leads to the backyard), and hallway bathroom. The licensee has added a door to connect the studio to the living room and would like to add it to the on limit areas. The home is neat and clean with heating and ventilation for safety and comfort. The OFF LIMIT AREAS are all bedrooms, dining room, master bedroom/ master bathroom, hallway bathroom, and kitchen which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the living room, and attached studio located through the double doors in the living room consisting of a bathroom, room, and hallway which leads to the backyard. The ISOLATION AREA will be the living room. Per licensee the wooden patio and upper deck part of the backyard will be off limits to children in care. Outdoor play area is fenced.

A notice of site visit was given and must remain posted for 30 days.

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Emily He.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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